January 27th, 2017

NCHH Authors Contribute to Three New Articles about the Impact of Healthy Housing Programs

COLUMBIA, MD (January 27, 2017) — The Journal of Public Health Management and Practice has published three articles online today about New York State’s Healthy Neighborhoods Program, which are expected to be of great interest and benefit to public health professionals and the healthy homes community. The March/April 2017 print editions will mail February 10.

The New York State Healthy Neighborhoods Program is featured prominently in the Journal of Public Health Management & Practice (March/April 2017 issue).

The New York State Healthy Neighborhoods Program (HNP) is a healthy homes program that provides in-home assessments and interventions in selected communities throughout New York State. During a visit, the home is assessed for environmental health and safety issues. For problems or potential hazards identified during the visit, outreach workers provide education, referrals, and products to help residents correct or reduce housing hazards related to tobacco control, fire safety, lead poisoning prevention, indoor air quality, carbon monoxide poisoning, radon, ventilation, cleaning and clutter, pests, mold and moisture, structural issues, asthma, and other health and safety issues. About 22% of homes receive an optional revisit, scheduled three to six months after the initial visit. During a revisit, the home is reassessed, and any new or ongoing problems or hazards are addressed.

The articles were co-written by Ms. Marta Gomez, a research scientist the New York State Department of Health (NYSDOH), and combinations of four staff from the National Center for Healthy Housing (NCHH): Dr. Sherry Dixon, Biostatistician; Dr. David Jacobs, Chief Scientist; Ms. Amanda Reddy, Director of Strategy and Impact; and Mr. Jonathan Wilson, Director of Research. The culmination of a 10-year data collection and evaluation effort, the study covers a four-year span of data, 2008 to 2012, across 13 New York counties. In total, the Healthy Neighborhoods Program visited 28,491 homes during the evaluation period; the program primarily serves low-income communities throughout the state of New York. The authors note that although this article contributes to a substantial evidence base about the potential of healthy housing programs to impact health positively, the evaluation is important and unique due to its large sample size, geographically diverse population (it serves both rural and urban communities), applicability to both pediatric and adult populations, use of lay workers, and its real-world setting. The program has been in existence since 1985, has been state-funded for over a decade, and is offered in both rural and urban areas of the state.

One resident of Rochester, Heather Floyd, experienced an immediate benefit from the Healthy Neighborhoods Program when community health worker Tami Divers arrived for a routine visit and inspection. Ms. Divers immediately noticed that something was amiss inside Ms. Floyd’s apartment. Ms. Floyd explained, “What happened was… I had just moved in, and… there was a gas smell in the house; and when [Ms. Divers] came, she smelled it, so we got the landlord right away. He came, he turned everything off, and they fixed the problem right after that.” And what was the source of this potentially explosive hazard? “The stove wasn’t hooked up properly,” said Ms. Floyd.

Ms. Floyd feels that the Healthy Neighborhoods visit has changed how she views and maintains her apartment. “[The home inspection] really got me, because I didn’t really smell that gas leak, that gas smell.” She continued, “It was nice that she came through. She came over and took the time out [of] her day just to go over things with me.”

Katrina Korfmacher, a local advocate, researcher, and practitioner, observed that in addition to benefiting individual residents, the program also provides a service to other organizations and programs, saying that “the Healthy Neighborhoods Program is a great resource where members of the Rochester Healthy Home Partnership can refer low-income residents who need to identify and address hazards in their homes. The program has also produced invaluable data about what are key housing quality problems and needs to address in our community.”

In the first article, “The New York State Healthy Neighborhoods Program: Findings from an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program,” the authors described significant improvements in tobacco control, fire safety, lead poisoning prevention, indoor air quality, and a decrease in pests, mold, and other hazards among homes revisited by the Healthy Neighborhoods Program, indicating that a comprehensive, low-intensity healthy housing approach can produce significant short-term public health impacts. The authors concluded that expanding the focus of existing programs to address multiple housing issues, especially common hazards that may be easily corrected, makes sense for programs already providing in-home services, helping more people in less time for less money than if the issues were addressed individually. As budgets tighten for public health interventions, the findings could influence and help to shape the development of future healthy homes programs and policies.

In two subsequent articles, the authors look at the impact of the program on asthma, a major focus of the 32-year-old program.

In “An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children,” the authors compared improvements in asthma outcomes for children and adults across three different recruitment groups. Following the initial visit, participants reported improvements in asthma-self-management, morbidity, healthcare access, and environmental conditions at home. There were differences between the recruitment groups, suggesting that targeting the intervention to people with poorly controlled asthma may result in a greater magnitude of improvement for some outcomes (like avoidance of asthma triggers and short-term health outcomes), but other recruitment strategies, like door to door canvassing, may be more effective for improving healthcare access and selected aspects of self-management. Across all three groups, however, improvement reinforced the growing evidence base that a low-intensity, home-based, environmental asthma intervention using nonclinical staff can decrease the presence of asthma triggers and improve asthma self-management and morbidity outcomes for both adults and children.

The final article, “A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents with Asthma: Findings from the New York State Healthy Neighborhoods Program” studied the financial benefits of the Healthy Neighborhoods Program for the healthcare system. The authors used a payer perspective in evaluating financial benefits, meaning that they only considered costs and savings that would accrue to a healthcare payer (like a Medicaid managed care plan) investing in this type of program. Overall, they found that the average cost of a visit was $302 and, depending on how the program is targeted to people with asthma, the potential healthcare savings ranged from $781-$1,083 per visit, for a benefit to program cost ratio of 2.03-3.58 (or a savings of $2.03 to $3.58 for every dollar invested in the program).

The article is accompanied by two commentaries authored by four federal agencies (the Department of Housing and Urban Development, the Centers for Disease Control and Prevention, the Environmental Protection Agency, and the National Heart, Lung, and Blood Institute). The articles, commentaries, and additional materials are all available online.

“Taken together,” commented Commissioner of Health Dr. Howard Zucker in an official statement, “this body of research provides clear and compelling evidence that our Healthy Neighborhoods Program is making a significant impact on health and healthcare costs. By working directly with residents in high-risk neighborhoods, the Department is directly improving the health of these New Yorkers.”

First Alert, the national safety products company, learned of the project’s success in late 2016, and offered to donate 1,000 carbon monoxide and smoke detectors in recognition of the program’s long-standing commitment to improving health and safety of housing in New York State communities. The detectors will be distributed among each of the 19 participating counties in New York State in 2017.

NCHH’s Amanda Reddy said of the project, “This evaluation, and others before it, offers a practical and cost-effective solution for increasing access to critical public health services. Other states struggling with issues like asthma, childhood lead poisoning, or other housing-related illnesses and injuries should look to the New York State Healthy Neighborhoods Program as a model for improving health by investing in housing-based services.”

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About the National Center for Healthy HousingThe National Center for Healthy Housing (NCHH) is the preeminent national nonprofit dedicated to securing healthy homes for all. Since 1992, NCHH has served as a highly regarded and credible change agent, successfully integrating healthy housing advocacy, research, and capacity building under one roof to reduce health disparities nationwide. You can follow NCHH on Twitter (@nchh) or LinkedIn or become a fan on Facebook at www.facebook.com/HealthyHousing.